Diagnosis of ventilator-associated pneumonia

Ventilator-associated pneumonia is difficult to diagnose and remains a sour ce of considerable controversy despite the recommendations of a consensus c onference suggesting bronchoscopic techniques to determine true aetiology. Wet mounts and Cram-stains of sterile fluids and urine are examined as a co mmon practice in most hospitals to guarantee the quality of the samples. Ho wever, only a few authors have emphasised the relevance of screening respir atory samples - a simple and economic means of evaluating the quality of sa mples and an indicator for the initiation of antibiotic treatment. The aim of this review is to demonstrate that decisions regarding empirical therapy can be improved if based on direct examination of the samples and appropri ate interpretation of the culture results. (C) 2001 Lippincott Williams & W ilkins.